Guidelines for the use of Oral Proton Pump Inhibitors in ...

Paediatric Clinical Academic Unit

Guidelines for the use of Oral Proton Pump Inhibitors in children

Written by: Andy Law (Pharmacy) Checked by: Rachel Bowman (Pharmacy) Approved by: Sandhia Naik(Consultant)

Date: June 2011

Indication

Gastro-oesophageal reflux disease and associated gastroenterology conditions

Background

Although only omeprazole is licenced for use in children1, there is no clinical significance between omeprazole and lansoprazole2,3,4. The advantage with lansoprazole is the plateau of dosage which allows whole tablets to be used, without the need to use unpalatable sodium bicarbonate 1 mmol/mL solution. There is also a financial advantage with using lansoprazole Fastabs? as it is significantly less expensive than using sodium bicarbonate oral solution with omeprazole.

Presentation

Omeprazole Capsules 10 mg and 20 mg Lansoprazole Fastabs? (dissolvable tablet) 15 mg and 30 mg

Paediatric Dosage Information (all ages)

30 kg

Omeprazole dose may be increased to 20 mg for patient 20 kg, 40 mg for patient > 20 kg Doses of whole capsule contents (10mg or 20mg) can be dispersed in water/puree/yoghurt and taken orally if tolerated Enteral feeding tube administration must use sodium bicarbonate 1mmol/mL to disperse omeprazole capsule contents ? consider switching to lansoprazole.

Either: Omeprazole capsules 20 mg once a day

Omeprazole dose may be increased to 40 mg once a day if necessary Doses of whole capsule contents (10mg or 20mg) can be dispersed in water/puree/yoghurt and taken orally if tolerated. Enteral feeding tube administration must use sodium bicarbonate 1mmol/mL to disperse omeprazole capsule contents ? consider switching to lansoprazole.

Or if patient cannot swallow whole capsules: Lansoprazole Fastabs? 15 mg ? 30 mg once a day

Fastabs may be sucked or dispersed in water and the granules will pass through an 8Fr enteral feeding tube5.

Adverse effects Both Lansoprazole and Omeprazole

? Nausea, vomiting, abdominal pain, flatulence, diarrhoea, constipation, dizziness, headache, dry mouth

References

1. BNFc 2010-2011 2. Zheng RN (2009). "Comparative study of omeprazole, lansoprazole, pantoprazole and esomeprazole for symptom relief in patients with

reflux esophagitis." World J Gastroenterol 15(8): 990-995 3. Dekel R, Morse C, Fass R (2004). "The Role of Proton Pump Inhibitors in Gastro-oesophageal Reflux Disease." Drugs 64(3): 277-295 4. Frazzoni M, De Michali E, Grisendi A, Savarino V (2002). "Lansoprazole vs. omeprazole for gastro-oesophageal reflux disease: a pH-

metric comparison" Aliment Pharmacol Ther 16: 35-39 5. Handbook of Drug Administration via Enteral Feeding Tubes online edition,

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